Dupuytren's Disease

Dupuytren disease is a condition in which the tissue beneath the skin of the palm gradually thickens and tightens. Over time, this can cause the fingers—most commonly the ring and small fingers—to bend into the palm and become difficult to straighten.

It is a chronic condition, but not usually a painful one. With careful monitoring and the right treatment at the right time, most people maintain excellent hand function.

Common Symptoms

Common early signs include:

A firm lump or “nodule” in the palm
Thickened cords running toward the fingers
Skin puckering or dimpling
Difficulty fully straightening one or more fingers

Symptoms often progress very slowly over years. Some people develop nodules that never form cords or contractures; others progress more quickly.

Why It Happens

The exact cause is not known, but contributing factors include:

Genetic predisposition (family history is common)
Northern European ancestry (not exclusively, it can happen in anyone, from anywhere)
Age (more common after 50)
Diabetes
Alcohol or tobacco use

Dupuytren disease is not caused by trauma or overuse, though symptoms sometimes become more noticeable after hand injuries simply because people look more closely at their hands.

Evaluating DD

Not all Dupuytren Disease requires treatment. I recommend intervention when:

A finger cannot fully straighten
Hand function is affected
The disease is progressing quickly
Contracture interferes with work, sports, or daily tasks

Early nodules without contracture are often simply observed.

Treatment Options

Treatment is individualized and depends on the pattern of disease and your goals. For severe Dupuytren's which is causing symptoms, three main options can be considered:

Needle Aponeurotomy (Percutaneous Release)

A minimally invasive technique performed through tiny skin punctures to release the cords and straighten the finger. Minimal downtime, rapid recovery. Not all patients are good candidates, but those that are can benefit from this technique.

Collagenase Injection (Xiaflex)

Medication is injected into the cord to weaken it, followed by gentle manipulation to straighten the finger. Useful for specific contractures. Similar outcomes to Needle Aponeurotomy but with higher cost, and higher risk of side effects like swelling, pain, allergic reactions.

Open Fasciectomy

A more formal surgery that removes the diseased tissue. Recommended when the disease is severe, recurrent, or involves complex skin involvement, or when the anatomy is such that a less-invasive procedure would be overly risky.

Recovery/Outlook

Recovery varies:

Minimally invasive procedures: days to weeks
Open surgery: several weeks to months
Hand therapy is often part of the recovery plan
Splinting may be recommended to maintain correction

While treatment can dramatically improve function, Dupuytren will nearly always recur over time because the underlying biology persists. Procedures can give patients months, years, or even decades, or relief before a recurrence, though. Every patient is different.

My Philosophy

I focus on:

Accurate staging of disease
Clear discussion of options
Choosing the least invasive treatment that will reliably work
Minimizing downtime
Partnering with skilled hand therapists when needed

The goal is to restore comfortable, predictable function while preserving future treatment options.